HomeMy WebLinkAbout12-05-13 (2) � 1505610105
REV-1500°``°Z_11,«' �
OFFICIAL USE ONLY
PA Department of Revenue P��Ylvarria
Bureau of Individual Taxes �"^p"""� County Code Year Rle Number
PO BOX 28o6oi � INHERITANCE TAX RETURN ��, /� �� �
Harrisburq,PA 1�1z8-o6o1 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
07/07/2013 02/19/1911
DecedenYs Last Name Suffix DecedenYs First Name MI
Ditzel George H
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1.Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death
Priorto 12-13-82)
p 4.Limited Estate O 4a.Future interest Compromise(date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
� 6. Decedent Died Testate O 7.Decedent Maintained a Living Trust _ 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD Bf[�1P�CTED TO:�
Name Daytime�ephone Num�� �
C�t
Mark K. Emery, Esquire (717)?��883 � � �
RF�S1'�R OF WILLS USE GI+�l(^�-i
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!�t � .�3 �;:�x
__ �: ,`,�:; � �-?,
First Line of Address f--� <-> •. `�'•� `n�i `''
�.. _.� .
c.: c:v� . _ .,-
410 N. Second Street : �: `
.. : C.� _ �:,"�
Second Line of Address -�� `� ��'
(1'1 i:r'7 �•:>
•R C� ��1
City or Post Office State ZIP Code DATE FILED
Harrisburg PA 17101
CorrespondenYs e-maii aadress: Mark@markemerylaw.com
Under penalties of perjury,I declare that 1 have euamined this retum,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,corted and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PER N RESPQNSIBLE FOR FILING RETURN ' DATE �� a i _ �3
� , � �
ADDRESS
6401 Colches r Avenue, Harrisburg, PA 17111
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 1505610105 15056101�5 J
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� 15d5610205
REV-1500 EX(FI)
DecedenYs Social Security Number
DecedenYsrvame: George H. Ditzel 201-10-4933
RECAPITUlAT10N
1. RealEstate(Schedule A). .................... . ..................... .. 1.
2. Stocks and Bonds(Scheduie B) ............................. .......... 2.
3. Closely Heid Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3.
4. Mortgages and Notes Receivabie(Schedule D)........................... 4.
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 12,942.62
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. 2,299.75
7. Inter-Vivos Transfers&Misceilaneous Non-Probate Property
(Schedule G) O Separate Billing Requested........ 7.
8. Total Gross Assets(total Lines 1 through 7)............................. 8. 15,242.37
9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. 13,487.36
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............... 10. 1,302.07
11. Total Deductions(total Lines 9 and 10)...... .......................... . 11. 14,789.43
12. Net Value of Estate(Line 8 minus Line 11) .............................. 12. 452.94
13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) ....................... . 13.
14. Net Value Subject to Tax(Line 12 minus Line 13) ................ ........ 14. 452.94
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(1.2)X.0_ 15.
16. Amount of Line 14 taxable
at lineal rate x.0 45 452.94 16. 20.38
17. Amount of Line 14 taxable
at sibling rate X.12 17.
18. Amount of Line 14 taxable
at collateral rate X.15 18.
19. TAX DUE .......... ............................................... 19. 20.38
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p
$ide 2
� 1505610205 1505610205 �
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
George H. Ditzel
STREETADDRESS
42 Garden Parkway
CITY STATE ZIP
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 20.38
2. CreditslPayments
A.Prior Payments
B.Discount
Total Credits(A+g) (Z� 0.00
3. interest
(3) 0.00
4. If Line 2 is greater than Line 1 +Line 3,e�ter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4)
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 20.38
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred.......................................................................................... ❑ �
b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ �
c. retain a reversionary interest .............................................................................................................................. ❑ �
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ �
2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................................. ❑ �
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ �
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designatio�? ........................................................................................................................ ❑ �
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994,and before Jan. 1, 1995,the tax rate imposed on the net vafue of transfers to or for the use of the surviving spouse
is 3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and
filing a tax retum are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
. The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an
adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)].
• The tax rate imposed on the net value of transfers to or for the use of the decedenYs lineal beneficiaries is 4.5 percent,exCept as noted in[72 P.S.§9116(a)(1)].
. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined,
under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
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REV-15o8 EX+(08-12)
� pennsylvania SCNEDULE E
DEPAHTMEMOFREVENUE CASH� BANK DEPOSITS & MISC.
INHERITANCE TAX RERIRN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
George H. Ditzel 21-13-0862
Include the proceeds of litigation and the date the proceeds were received by the estate.
Ali property jointly owned with right of survrvorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIFTION OF DEATH
�. M&T Bank Acxount. See Account Statement attached hereto 9,942.62
2 1971 Star Mobile Home. Title,appraisal and sales receipt attached hereto. 3,000.00
3 Personal belongings 1,000.00
TOTAL(Also enter on Line 5, Recapitulation) $ 12,942.62
If more space is needed,use additional sheets of paper of the same size. '
.
. .
ACCQUNF NQ.``, ACCOUNT 1"YPE STATEMEPtT P€ItI4D NAGE
9842595168 M8T CLASSIC CHECKING N/INTEREST .lUN.22-JUL.23,20T3 1 OF 1
00 0 04344M NM 017
000003916 FIDS1549D01707231307 02 001000 13411
x�
�� GEORGE H DITZEL JR
�•t 42 GARDEN PKWY
CARLISLE PA 17013-9221
INTEREST EARNED FOR STAFEPIENT PERYQb �i.08 SP�tING �A�31�Ek
INTEREST PAID YEAR TO DATE 0.53
ACCOUtvT SlfM�IA�tY
9£G3.NN�NG <DEF'�ST�5'� QTHCR. �URCtF4�T : < �NDxNG
BAIANCE OTNER ADDITIfiNS : CHECKS l�Ala SUHTRACTIfDlrS fNFEftESF :PiZ BALANCE
N0. AMOl1NT � �10. ANOUHT N0. AMOUNT
9,155.60 1 1,169.00 2 381.98 0 � 0.08 ^^ 0.09 9,942.�1
ACCOUNT ACTIVI7Y
'.?OSTING D�PQS�T$,INT�ti�ST ': CHECKS S dTH�R DAILY ;.
; DA7E : ' TRANSACTION DESCRIPTION ' & OTHER ADDITIONS SUSTRACTIONS B:ALANCE !
�
' 06-22-13 BEGINNING BALANCE 59,155.60
�
- 07-01-13 CHECK NUMBER 0977 7I.98 9,083.62
' S:'-3.7.-:.3 SS� 'l�i€.",.�'. T.30 �X.''..^.t. :�:. � J.,1,',9.9�
� 07-03-13 CHECK NUMBER 0978 I 310.00 9,942.62
� 07-23-13 INTEREST PAYMENT O.n9 9,942.71
�
; ENDING BALAi�CE 59,942.71
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` CHECI(S P{4ID SI2MMARY
� _ �_
,
977 07-01-13 71.98 978 07-03-13 310,00
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ANYUAL PERCEW7AGE YIELD EAftNED = O.itO %
L008(6/12)
IMPORTANT— FOLLOW "T'HESE INSTRUCTIONS
1. °.RI��T IN'INK OR TYPEWRITE ALl INFORMATION.
2. UPON TRANSfER OF OWNERSHIP Of THE MOTOR VEHICLE OR TRAILER DESCRIBED MEREIN, THE ASSIGNMENT (BLOCK A) OR THE ASSIGNMENT AND REASSICiNMENT
(BLOCK A 8 B) WITH THE PURCHASER'S APPLICATION {BLOCK C) MUSi BE COMPLEiED AND fORWARDED TO THE DEPARTMENT OF TRANSPORTATION, BUREAU
OF MO1.DR VEHICLES. WITHIN (151 DAYS.
iP 3. WHEN REASSIGNMENT (BLOCK 8) IS BY REGISTERED PENNSYLVANIA DEALER NO FEE IS REOUIRED.
� 4. WHEN PURCHASER'S APPLICATION (BIOCK C) IS BY REGISTERED PENNSYLVANIA DEALER THE FEE IS 50.50.
5. INDIVIDUA� OWNER MUST SIGN EXACTLY AS NAME APPEARS ON CERTIFIGATE OP TITIE OR ASSIGNMENT. IN CASE OF JOINT OWNERSNIP COMP�ETE SIGNA-
TURES OF'EACH OWNER REOUIRED. IF COMPANY OR CORPORATION. SIGN FIRM NAME PER AUTHORIZED REPRESENTATIVE.
6. REMIT REQUIRED FEE BY CHECK OR MONEY ORDER PAYABLE TO THE "PENNSYLVANIA DEPARTMENT OF TRANSPORTATION." D� ND4 SEWD CiaSF9,
A. ftSSIGNMENT OF CERTIFICfATE �F TITLE IrlUt�tE�R: �� ���
We, 1, transFer ownership of this motor vehicle or trniler to: � ,
� We, I, warran� this Ccrtiiicate of Title, and state that at thc t�me of
delivery the same is sobject to the iollowing encumbrances or other legal
a ��IJ� claims:
r ►�—i� Y�i ����e.�� ����
NAME OF PURCHASER n AMOUNT $ IF�"NONE"� SO STATE
C?� � Q I�
ADD �SS � ENCUMBRANCE HOLDER
� r � l�� �c I`1C�I�
POST OFFICE STATE ZIP CODE ADDRE55
Registered Pennsylvania vehicle dealers must
show� their dealer identification number here: PosT OFFICE STATE ziP CODE
sue�u > ; >ah�H�LI"seOF� Mr �rF3�s � i� � /� �, .//'
�. o+ �
E � oN TURE SELLER IN IN � ; -
A 516NATURE G, G �11b�IC /� �.if;'/� ' y�� �)/ (,�/� '�/ lf '� ,/�
L MUNICIPALI 9$�pn � � �/" ! C.� �/�K., /� �� /�i U
�fQ$ �y 2 R AME XACTLY AS IT A P ARS ABOVE
MY COMMISSION EXPIRES ,,,� 4•2��ry�� DO NOT SIG UNLESS PURCH SER'S AME AND ADDRE55 PPEAR ABOVE
B. REASSIGNMENT OF CERTIFICATE OF LE ��� �'�,dd*
We, I, transfer mvnership of this mowr vehicle or trailer to: We, 1, warrant this Certificate of Tide, and state that at the time of
delivery the same is subject to the foliowing encumbrances or other legaL
claims:
NAME OF PURCHASER AMOUNT $ IF "NONE" SO STATE
ADDRESS ENCUMBRANCE HOLDER
POST OFFICE STATE ZIP CODE ADDRESS
Registered Pennsylvania vehicle dealers must
show their dealer identification number here: Posr. oFFice sTnTE ziP CODE
SURSCRIBED AND SWORN TO REFORE ME THIS �� �
S DAY OF IH
E SIGNATURE OF SELLER IN INK
A SIGNATURE OF PERSON ADMINISTERING OATH .
L MUNICIPALITY COUNTY
MY COMMISSION EXPIRES �y PRINT NAME E7CACTlv AS IT APPEARS ABOVE
DO NOT SIGN UNLESS PURCHASER'S NAME AND ADDRESS APPEAR ABOVE.
!' C. APPLICATION FOR CEFTIFICATE OF TITLE BY PURCHP�SER �gg ��.0{��
� The undersigned hereby makrs application (or Certiiicate of Title to thr mo�or vehicle or Is this motor vehicle or trailer subjec�to any encumbrance other than as
� ttailer descnbed within this Ceruiicate of Tide, subjecl to the encumbrances and other se�iorth a6ovr? If so complete the following:
�� legal claims se[forth in the above assignmem or rcassignment.
AMOL'N'I' 3
IF "NONE" SO STATE
Registered Pennsylvania vehicle dealers must
� show their de k ntification number here:
� ENCUMBRANCE HO{�DF��
o SUBSCRI ED ' + j,'���F�O�RVi� E THIS �`.J
� � ! D C7F'� IQL�� `UYL�lFj�� ^�„ ADDRESS
¢ - ` '7
S '��.1�
n E R �� O �,�u « POS OFFICE � STATE ZIP CODE
LL A SIGNATURE O P •83 p��Rp.,
.. � � —...p �
� L, MUNICIPALITY ""���.,.�,OUN � '
W MY COMMISSION EXPIRES '1°'�'�y IGNATURE OF PURCHA E N K
u SIGNATURE MUST AGREE ABOVE ASSIGNMENT OR REASSIGNMEtdT
< D. APPLICATION FOR (cHECtc oNE) (DEPARTMENT USE ONLY)
z
4 ❑ NEW REGISTRATION PLATE Title Numbcr R❑ NR❑
�
0
0
< ❑ TRANSFER OF REGISTRATION PLATE NUMBER
❑ REISSUE AND TRANSFER OF REGISTRATION PLATE NUMBER REISSUE REASON
1. New registration Plate iee see face o( title (LOST. STOLEN, DEFACED)
2. Passenger and motorcycle 1/2 fre beginning Oct. 1, 1/4 (ee beginning Jan. 1
3. Commercial, bus and trailer 1/2 iee 6eRinning Dec. 1, 1/4 fee beginning Mar. I
4. School bus 1/2 fee beginning Jan. 1, I/4 fee beRinning April 1
5. Transfer fee 52.00 when vehicle is o(like class,or f2.00 plus di�ference in Fee i�class is higher. SIGNATURE OF APPLICANT IN INK
6. Reissue fee 51.00 except motorcycles, when the fee is 50.50 NOTLISUSPENDEDBY AVERS THAT HIS REGISTRATION PRIV�LEGES ARE
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COMMONWEALTN OF PENNSYLVANIA CONTROL NUMBER
.
, DEPARTMENT OF TRANSPORTATION � �.
CERTIFICATE OF TITLE TO A MOTOR VEHICLE OR TRAILER �� `? � � � � a ;;�
2 0—9 0 8 �'� a ',:�
'�•^ 4 /, th�� Secreta�.y nJ� Tra�ispurtalian ccrtift� lh�rt an rrppli<•ation Ira.t hc�err mude tu rn��, pursuartt tu tlte Act vf Apri! 39, _
`"^ 0 145�1, l'.L. Sb'u.ti�umcndtrti, Ji�r u Certi,/icutu of 7'itl�� t�, Ihc malor vcl�icic or lrailar Jc.r�a�ihcd licreun.
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T17LE NUMEiER MAKE GF VENICLE T'�'('F MANUFACTURERS SERIAL NUMB[R Ap �`
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�;; b this Certrjic�atc nf Title arn true, urrc! thut J an� .rutisjred tliat the applic.ant is ihc lawful owr��' Q
'' d r/,� ,n�,rnr v,�h�clr nr rrailer �lescribcd hcr�c�,n, nr is olhcrwisc er�titlhd �o hauc the same r'�is� q
" ' in his name. � =
+,;:� p k�hcrefure, I certifi� llrat !he uhove named up��licu�r/ lius heen duly registered in �, �`� . .ti
'�r'= °• of the Pcnnsylvania 1)epartrnent af T'rans����rlatiort as t}re lau�ful own�r of !he m��/or t{�tic�
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+•.:: ° Secretary �f 7'ransp�rtation � �'�°
KEEP IN A SAFE PLACE—ANY AITERATION OR ERASURE VOID5 7H15 TITLE
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" _ _ - - _— _ ��=.:`_i�L•=., :=Li��;���,'C�!.=.i�`:i� �70I3
8/3/13
TO WHOM IT MAY CONCERN:
THE MOBlLE HOME LOCATED AT 42 GARDEN PARKWAY'S VALUE WOUID BE$3,000.00.
THIS HOME IS A 1971 STAR SERIAL#GAMCXMMO-2394.
SIGMAN'S HOME SALES
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OSHUA E. SIGMAN
OWNER
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REV-isog EX+(ol-i0)
�,�i pennsylvania SCI�IEDI�LE F
'i' DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN 70INTLY-OWNED PROPER7Y
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER;
George H. Ditrel 21-13-0862
If an asset became jointly owned within one year of the decedenYs date of death,it must be reported on Schedule G.
SURVIVING]OINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A•Wendy A. Freyvogel 6401 Colchester Avenue, Harrisburg, PA 17111 Daughter
e.
C.
]OINTLY OWNED PROPERTY:
tErrER DA� DESCRIPTION OF�tOPERTY %oF DA�oF DeaTti
IfEM FOR]OINi MADE INCLUDE NAME�FINANQAL INSTfNTION AND BANK ACCOUNT NUMBER OR SIMILAR DA7E OF DEA7H DECIDENTS VALUE OF
NUMBER TENANT JOiNT IDENTIFYING NUMBER.ATTACFi UEED FOR lOINTLY HftD REAL ESTATE. VALUE OF ASSEf INTEREST DECEDENT$INTEREST
1' A' 01/02l81 M8T Bank Acxount,account#21000000983933. See attached Notice of 4,599.51 50 2,299.75
Decedent Acxount Status
TOTAL(Also enter on Line 6, Recapitulation) $ 2,299•�5
If more space is needed,use additional sheets of paper of the same size.
Financial Institutions Page 1 of 1
Notice of Decedent A�ccount Status
Please verify your information.
Submit Date: O8/31/2013
Decedent information
Social Security Number: 201-10-4933
Date of Death: 7/7/2013
County: 21-CUMBERLAND
Name: Ditzel, George H
Address: 42 Garden Parkway
Carlisle PA 17013
Financial Institution Information
Name: M &T BANK
Address: 1 M & T PLAZA 20TH FL
BUFFALO NY 14203-2301
Account Information
Type of account: Joint Savings
Account Number: 21000000983933
Original Date Account was Established: 1/2/1981
Account Balance: 4,599.51
Rollover Date:
Account Title: George H Ditzel ]r and Wendy A Freyvogel
Joint survivor/beneficiary information
If any of the survivors listed below should not be on this account, click the box
under Delete to delete the survivor from this account.
Delete SSN Relationship Name
�"�? 470-44-9572 Child Wendy A Freyvogel
To print this page for your records, click on your browser's 'File' menu, and then click 'Print'.
Return To Survivor Information Submit
� C�,rrent Form: 1S40�arm/Ftevl549Cqnfiirrn.�scx
A;.CCllnt: iC�: �a'Jn
U,rr ROIP.: Unk��o.v^
https://www.doreservices.state.pa.us/financialinstitution/Default.aspx 8/31/2013
REV-1511 EX+ (OS-13)
� pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
George H. Ditzel 21-13-0862
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1" Hollinger Funeral Home. See Contract and expense summary attached hereto. 10,994.32
2 Hollinger Funeral Home,engraving cost. See attached invoice 150.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s) _
Street Address _ _
City State ZIP
Year{s)Commission Paid:
1,659.54
2. Attorney Fees:
3. Family Exemption: (If decedent's address is not the same as claimant's,attach expianation.)
Claimant
Street Address
City _ State__ ZIP
Relationship of Claimant to Decedent _
4. Probate Fees: 383.5�
5. Accountant Fees:
6. Tax Return Preparer Fees: 300.00
7.
TOTAL(Also enter on Line 9, Recapitulation) $ 13,487.36
If more space is needed,use additional sheets of paper of the same size.
ie+
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Hollinger Funeral Home & Crematory, Inc.
Eric L. Hollinger.Supernisor
July 15, 2013
Wendy A. Freyvogel
6401 Colchester Ave.
Harrisburg, PA 17111
The Funeral Service for George H. Ditzel
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please
feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES,AUTOMOTIVE EQUJPMENT,AND
MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
Professional Service
Traditional Services $ 5150.00
Merchandise
Haven Line American Chestnut(Libra) 2095.00
Concrete Reinforced Vault 1250.00
Memorial Package—Register Book, Memorial Folders,
Acknowledgement Cards, Bookmarks 175.00
AT THE TIME FUNERAL ARRANGEMENTS WERE MADE,WE ADVANCED CERTAIN PAYMENTS TO OTHERS AS AN
ACCOMMODATION. THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES.
Cash Advances
Certified Copies of Death Certificate(12@$6) 72.00 � �,
Flowers—Casket&Hinge Spray,Satin Heart 332.84 �� � v
Sentinel Newspaper 274.26 � �
Patriot Express 345.22 �. ''
Minister 150.00 �
Organist 75.00 �
Grave opening 700.00
Cemetery equipment 375.00
Total Expenses 10994.32
Received 7/8/13 - 2275.00
BALANCE $8719.32
501 NORTH BALTIMORE A`�ENllE • MOUNT HOLLY SPRINGS. PENNSYLC7ANIA 17065 • (717) 486-3433 • FAX(717) 486-3215
www.fiollingerfuneralhome.com
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Hollinger Funeral Home & Crematory, Inc.
Eric L.Hollinger,Supervisor
Wendy A. Freyvogel
6401 Colchester Ave.
Harrisburg, PA 17111
The Engraving for George H. DitzeL•
We sincerely appreciate the con�dence you have placed in us and will continue to assist you in every way we can. Please
feel free to contact us if you have any questions in regard to this statement.
Engraving-150.00
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501 NORTH BALTIMORE AVENUE • M011NT HOLLY SPRINGS.PENNSYL\7ANIA 17065 • (717) 486-3433 • FAX(717) 486-3215
www.hollingerfuneraIhome.com
REV-1512 EX+ (12-12)
� pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX REfURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
George H. Ditzel 21-13-0862
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VAIUE AT DATE
NUMBER DESCRIPTION OF DEATH
1• Mobile home insurace. See statement of Shcemaker Insurance,attached hereto 304.00
2 Electricity. See statement of PPL attahced hereto 23.37
3 Propane. See statement of Aero attached hereto 58.21
4 Cable. See 2 statements of Comcast attached hereto 137.42
5 Ambulance service. See statement of Cumberiand Goodwill fire Rescue EMS,attached hereto 57.80
6 Telephone. See 2 statements of Century Link,attached hereto 48.13
7 Carpet cleaning of mobile home. See invoice of Stanley Steamer attached hereto 179.14
8 Removal of junk from mobile home. See invoice of 1-800-GOT-JUNK attached hereto 494.00
TOTAL(Also enter on Line 10, Recapitulation) $ 1,302.07
If more space is needed,insert additional sheets of the same size.
** REMINDER NOTICE **
Your Authorized Agent: 1-717-486-7777
SHOEMAKER INSURANCE& FINANCIAL AMERICAN M�N HOME
SERVICES INSURANCE COMPANY
502 C NORTH BALTIMORE AVE.
MT HOLLY SPRINGS PA 17065 Date Prepared: 07/25/2013
.y
�� Policy Type: MOBILE HOME
-- � Policy Number: 077 000 692 45 75
*� � '�f
�'�, v , Agent Name: SHOEMAKER INSURANCE&FINANCIAL
�y� v--s.,;:
C 077 020090 0006924575 37 000 � ��� Important Polic Information
GEORGE H DITZEL \�`��:-�, Mi ni mum Amount Due: $83.00
42 GARDEN PARK WAY Incl udes Charg es : $7.00
CARLISLE PA 17013 pay�i ntF�l l Date:$�04�002013
Property Address: 42 GARDEN PARK WAY CARLISLE, PA 17013
Important Information for GE�RGE H DITZEL !.
We have not received your payment as of 07/25/2013. We must receive your
payment before 08/09/2013 in order to ensure continuous coverage. Otherwise,
your policy w�iil �termina�:e at 12:01 A.hi. Standard iime on U8/09/2U13 for
nonpayment of premium. You may pay the minimum due of $83.00 or pay your
policy in full of $304.00 .
If payment is received after the stated expiration date on this notice, we will
review your policy for reinstatement, but there is no guarantee that we will
reinstate coverage. If the policy is reinstated, we will notify you of the
exact date and time of reinstatement and you may be assessed a charge.
ARE YOU PREPARED FOR TORNADO SEASON?
Tornadoes can strike quickly, with little or no warning. Every state is at
some risk from this hazard. Did you know that tornadoes are most likely to
strike between 3 p.m. and 9 p.m.? If you are in your home or school , you
should go to the lowest building level or other pre-designated shelter.
Caught driving or outside with no shelter? Lie flat in a nearby ditch or
depression and cover your head with your hands . For more information,
(CONTINUED ON REVERSE SIDE)
Pavments can be made bv.r,heck�r rra.�ir rar�i a+am�n���„ h.�m^�I����,,-„�,�.�.-.,�:_,,,,,_„.�,.._.:.:-,,,,�:,,_�_,..._., _.,. _ : . . . . ,,...- _. _ . ._
Questions?Please Visit us online at Page 1
�"¢`` �°'5�mw � contact us by Aug 22. � pplelettric.com
1-800-DIAL-PPL ` �' � ' , �
�� ¢"♦' (1-800-342-5775)
arx.��wG un�ro�� M-F: 8am to 5pm 66420-85001 Aug 22, 2013 ��„��.�i'7 :
Your Electric Usage Profile Billing Summary (Biiling details on back)
Seroice to: Balance as of Aug 1,2013 $0.00
6EORGE DITLEL Charges:
42 GARDEN PARKWAY L 84 Total PPL Electric Utilities Charges $23.37
CARLISLE, PA 17013
Meter:30704049 Total Charges $23.37
Your next meter reading is on or about Aug 30, 2013. �������.�,��������:���� , t���.��;
This section h�lps you understand your year-to-year Account Balance $23.37
electric use by month. Meter readings are actual unless pp�Electric Utilities' price to compare for your rate is$0.08227 per kWh.
otherwise noted. This changes the 1st of Mar,Jun,Sept,and Dec. Visit papowerswitch.com
■2012 �2013 or www.oca.state.pa.us for supplier offers.
L zo Your Message Center
y 16 • With paperless billing,you can receive and pay your
,� PPL Electric Utilities bills online.The process is free, -
� sz quick,convenient and secure.To learn more or sign up,
a $ visit pplelectric.com.
Q • Information about appliance energy use and tips on
4 saving energy are available through the Energy Library �
� on our Web site, pplelectric.com. �
J F M A nn � � A s o N D . Before digging around your home or property,you o
Months should a►ways call the state's One Call notification
system to locate any underground utility lines. You can
. r � � do this by simply dialing 811,which will connect you to
. �. . r`, � the One Call system. Be safe and call 811 before you
dig.
Aug 2013 30 81 3 77F
Aug 2012 30 263 9 78F —
'- � •� •� Payment Methods
Aug 1 Actual 28674 � pnline at: Q By phone: 1-8�-342-5775 =
Jul 2 Actual 28593 pp�electric.com or call BiltMatrix(service fee applies) _
at 1-800-572-2413 to pay using Visa, =
30 Days kWh Billed 81 MasterCard, Discover or debit card. ='�
. � .. . . . . � By Mail: Correspondence should be sent to: _
Sep 2012-Aug 2013 2514 � 210 Z North 9th Street Customer Services _
CPC-GENN1 827 Hausman Road =
Sep 2011-Aug 2012 2814 235 Alientown, PA 18101-1175 Allentown, PA 18104-9392 —
Other important information on the back of this bill-�
, *
Your Default Suppiier Contact tnfo. Billing Details - (aiu Acct. ss42o-85001j Page 2
For questions regarding the generation and transmission previous Balance
portions of this bill,please contact your supplier at: $30.44
� PPL Electric Utilities Phone: Payment Received Jul 23, 2013-Thank You! -$30.44
Customer Services � 1-800-342-5775
827 Hausman Rd (1-800-DIAL-PPL) Balpnce as of Aug 1,2013 $0.00
Allentown, PA 18104-9392 Charges for-PPL Electric Utilities
pplelectric.com Residential Rate: RS for Jul 2-Aug 1
Distribution Charge:
Custamer Charge 14.17
Manage Your Account 81 kWh�t 3.06400000C per kWh 2,48
System Improvement Chg at 0.43000000% p.07
Visit pplelectric.com for self-service options PA Tax Adj Surcharge at-0.07300000% -0.01
including: Transmission Charge:
-View your bill,payment, and usage history. 81 kWh at 0.91100000C per kWh 0.74
-Make a payment,set up a payment agreement. Generation Charge:
-Start/stop service. Capacity and Energy
-Enroll in paperless billing,automatic bill pay, 81 kWh at 7.32300000t per kWh 5.93
budget billing. PA Tax Adj Surcharge at-0.08500000'� -0.01
-Report an outage, check outage status,and more. Total PPL Electric Utilities Charges $23.37
View your rate schedule at pplelectric.com/rates or Amoun#�ue By:Aug��,ZQ�� ' ���_��:
call 1-800-342-5775 to request a copy.
Account Balance $23.37
General Information
Generation prices and charges are set by the electric
generation supplier you have chosen. The Public � , �'�
Utility Commission regulates distribution rates and '�°
services. The Federal Energy Regulator Commission �'�/� �� '� `ss�
regulates transmission prices and services. �`�
PPL Electric Utilities uses about$0.02 of this biil to pay
state taxes and about$1.37 is used to pay the PA
Gross Receipts Tax.
Understanding Your Bili
Customer Charge- Monthly basic distribution charge to cover State Tax Adjustment Surcharge-Charge or cretlit on electric
costs for biiling, meter reading,equipment, maintenance and rates to reflect changes in various state taxes included in your
advanced metering when in use. bill. The surcharge may vary by bill component.
tDransfoume�sCsubgtations and otheeequipm�ent used to deliver electricity from aagenerat,on fac�ilitmy to�thehdishtributtion lines of
electricity to end-use consumers from the high voltage an electric distribution company.
transmission lines.
Type s)of Meter Readings:
System Improvement Charge -A charge used to recover costs A ual-Reading by distribution company.
for repairing,improving, pr replacin distribution facilities in
order to provide safe, reliable, and e�icient service.
g;.;,::F�;
Generation Charge-Charge for the production of electricity. !=��;;
kWh(Kilowatt-hour)-The basic unit of electric energy for
which most customers are charged. The amount of electricity
used by ten 100-watt lights left on for 1 hour. Consumers are
usually charged for electricity in cents per kilowatt-hour.
Rate RS- Rate for service to a private home.
Customer Name Delivery/Service Address Cust# Invoice# "Inv Uate
GEORGE DITZEL ESTATE 42 GARDEN PARKWAY-CARLISLE,PA 17013 145054 6939279 2013-10-03
Quantity ,' ItemNumber Description' UnitPrice TOTAL ;,
-45.00 22-PROPANE PROPANE $1.2935 -$58.21
-45.00 Gallons @$1.2935/gallon
Delivered By: on 10/03/2013
Starting Meter Reading:0, Ending Meter Reading:-45.00
0.00 Reaulatorv Fee Regulatory Fee $6.1000 $0.00
Tank/Equipment: Fuel Tank-Tank:2-PROPANE � ,
For Fuel or Service At � � Sub Totai -$58.21
f �� t-�` v
� ; t Charges $0.00
i, . �. '�...5
; �1 ; Tax Total $0.00
. -
'��ACC NT BALANCE -$534.46 TOTAL DUE -$58.21
�
Mid-Atlantic Coop Solutions INC.
230 Lincoln Way East
New Oxford,PA 17350
1-800-998-4311
www.AeroEnergy.com
_ ___
comcast3 Account Number 09547 37917&01-0
Billing Date 06/14/13 '
' Totai Amount Due $71.98
', Payment Due by 07/07/13
Page 1 af 2 '
;
Cantact us ���www.comcast.com��� 1-888-931-1379 _____ _
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,
GE4RGE DITZEL � � ���' �"'w��"��"�'` ��: � �'�' ,� R � � a9 �
Previous Balance 71.98
For service at: �, Peyment-05/28/13-thank you -71.98
42 GARDEN PKWY :.��_,
CARLISLE PA 17013-9221 =��y New Charges -see below 71.98 `
��-;.,,� Total Amount Due $71,98
News from Comcast Paym��t o�e �y a�io7r��
(�uestions? Call 1-800-XFINITY(1-800-9346489) �K �� ro ,�,,���'�� ��.� � : , .;� ,
'�:`�����, ����'�,"�k � ��r �
Thank you for your prompt payment. ' �;��XFINIIY N��� 69.95���
For your convenience, we now accept regular and Taxes, Surcharges & Fees ' 2.Q3 �
automatic monthly credit card payments and direct Tota1 New Charges $71.98 �
debit.
Hearing/Speech Impaired Call 711 � � t
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��"������� Account Number 09547 379178-01-0 '
I Biiling Date 06/14/13
S@NIC@ D@t81IS ; Total Amount Due $71.9$
Payment Due by 07/07/13
Page 2 of 2 �
Contact us:�iM=��www.comcast.com��� 1-888-931-1379 ;`
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... . V�.0 .;�� ��t� .�a.!�. ��°,k�,�u��&a.u�N:i.1 . , i-:��iY n��.'mve..� � ���u�,...� �s';i�"
Limited Basic 06128- 07/27 21.99
.............................................................................................................................
Expanded Basic 06/28- 07/27 47.96
Total XFINITY N $69.95
,�yy�z� ', " '� � '� ',�5.' r' ��. s ll" .��� ��,Y� r��4V��,Mj �
aurye .�"'� y,1 �
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"�4 u ��«,aH.� �:�s� ��n��� an�ul�, l t�r?^�8.. ��'����t"r,�1�ia.�&,�,�rt���,a.� ��,s �ti���
�Tl/
Franchise Fee 06/28- 07i27 1.79
.........................................................................................................................�---
Sales Tax 06/28- p7/27 0.16 -
........................�--...................................................................._...............---...........
FCC Regulatory Fee 06/28- 07/27 0.08
Totai Taxes,Surcharges 8�Fees $2.03
IMPORTANT INFORMATION: Effective July 30, 2013,
Fox Soecer and Fox Soccer HD will move from Digitai
Preferred to Digita�Starter. The Display numbers will not
change.
The portions of your Xfinity television and intemet services
subject to sales tax are stated below(note that franchise fees
imposed on any taxable video charges are also subject to sales
tax):
Premium, Pay-Per-View or Video Equipment $2.70
.--- _._ _..__.__ . _____. .__---
_.__._ ___._.. -_..
�����S�Q ' Account Number 09547 379178-01 0 �
; I
� Biiling date 08/07/13 �
i Totai Amount Due $4.63 i
Service Details � Payment Due by 09/01/13 �
� Page 2 of 2
Contact us: �� www.comcast.com 1-888-931-1379 t.._,.....__..........--- --------T.—.-_�.�
subject to sales tax are stated below(note that franchise fees
� ,;,� � . �. . imposed on any taxable video charges are also subjed to sales
�-��"� tax):
Because we had aiready biiled you when the latest
changes were made to your account, we have adjusted Premium, Pay-Per-View or Video Equipment -$2.53
this bill. Listed in this section are credits and/or charges �
for these changes. � � �
Effective 07/29/13, Limited Basic at$21.99 per � �
month and Expanded Basic at$47.96 per month were
removed. � �
Adjustments for previously billed services removed �
07/29/13
Limited Basic 07l29- 08/27 -20.57
29 days @ $0.7093/day based on a monthly rate
of$21.99
-� -._- - .__....--... -.__......� - ---...--..._...__._...
Expanded Basic 07129- 08/27 -44.87
29 days @ $1.5472/day based on a monthly rate
of$47.96
Total Partial Month Charges&Credits �65.44
�
N
FCC Regulatory Fee 07129- 08/27 -0.08
.......................�---�----�---......................................................................................:..
Sales Tax 07/29- 08/27 -0.16
.............................................................................................................................
Franchise Fee 07/29- 08/27 -1.68
Total Taxes,Surcharges 8�Fees -$1.91
The portions of your Xfinity television and internet services
Lobby Hours Closed Captioning Customers: For assistance call
339 Baltimore Rd Shippensburg, PA 17257 (800)266-2278 or go online for email or live chat at
Mon-Fri 9am-5pm, Sat 9am-1 pm www-comcast.com/support. For written concerns contact N.W.
Patel, Comcast Closed Captioning Office, 1701 John F.
4601 Smith St HaR'isburg, PA 17109 Kennedy Blvd., Phila., PA 19103-2838,email:
Mon-F�i 9am-6pm, Sat 8:30am-4pm Closed_Captioning�a Comcast.com,fax:(215)286-4700 or call
our closed captioning line (215)286-8000.
Franchise Authority: An administrative late fee of$7.95 will be assessed on
PA0545 South Middleton Twp accounts not paid within 38 days of the Billing Date of the
520 Park Dr Boiling Springs, PA 17007 invoice,and additional late fee will be assessed day 68 of the
billing cycle. To ensure proper credit, refer#o the due date on
the invoice and allow 5 to 7 days for mailing and processing. If
your payment is not reflected on the invoice, it may not have
been received by the date the statement was printed.
,._._ ____ _.__._ . _.__ _ _ _._____ _._.__....
com�astP � ,
Account Number 09547 379178 01-0
Biiling Date 08/07/13
; Total Amount Due $4.63 j
', Payment Due by 09/01l13 (
Page 1 of 2
Contact us: ��t�� www.comcast.com ��� 1-888-931-1379 ���•. 1�
GEf3RGE DITZEL �
Previous Balance 71.98
For service at: P�yments- received by 08/07/13 ; 0.00 '
42 GARDEN PKWY
CARLISLE PA 17013-9221 New Charges -see below -67.35 ,
7'otai Amount Due $4 G3 '
N@WS 'ft"4t'1'1 COfI'1CaSt Payment Due by ��: .. � �09/�1/�13 `:
We regret losing you as one of our subscribers. Our ;;,i� � , ,
records indicate that the finai balance shown above is '� "
now due. Your prompt payment is appreciated. Any ;��� Partial Month Charges &Credits ' �65.44 `
outstanding equipment must be retumed to our office `—�'`� Changes were made to your accauni this.month.:
See the following pages for more detaf/s.
within 7 days. Please call us at 1-800-COMCAST any o
time should you wish to reconnect your service. 'Taxea; Surcharges &Fees -1.91 ` o
Hearing/Speech Impaired Call 711 Tatal New Charges -$67.35 '
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��mCaSt� Account Number 09�47 379178-01-0
Payment Due by 09/01/13
PO BOX 985 Total Amount Due $4.63
TOLEDO OH 43697-Q985
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Cumberland Goodwill Fire Rescue EMS
Billing Office 13-172482 6/27/2013 $57.80
PO Box 726 -
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New Cumberland, PA 17070-0726
QtlESTIOMS A80UT TH3S BILL? Phone: 877-214-6018 Espanol: 866-724-4114 Fax: 717-214-602U Email: info@ambulancebillingoffice.com
Date of Service: 6/22/2013 13:00 Please visit our website to provide insurance or make payment, and
Patient Name: DITZEL,GEORGE W. for additional payment options and frequently asked questions:
From: Carlisle Regional Medical Center www.ambulancebillingoffice.COm
To: CLAREMONT NSG&REHAB-CUMB CTY
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This type of seruice is not covered by ambulance memberships, Medicare, Medicaid and most secondaty insurances Payment
isyour responsibility.
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6/22/13 Wheelchair Van One-Way Trans A0130 1.0 48.00 48.00
6/22/13 Mileage S0209 5.6 1.75 9.80
Total 57.80 0.00 0.00
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P.O. Box 1319
Charlotte, NC 28201-1319
Account Name: GEORGE H DITZEL Page: 1 of 5
Account Number: 313648437 Bill Date: Jul. 01,2013
Contact Numbers Current Charqes Summary Detail Page
Product,Services and Billing
1-800-201-4099 0 CenturyLink Local Sarvices 3 38,37
Repair Service �,
1-800-788-3600 CenturyLi�k Long Distance Services 5 6.21
Payment or Account Balance 24/7 Total Current Charges 44.5$
1-800-201-4099
High Speed Internet Tech Support 24/7
1-800-788-3600 -
Dial-up Internet 24/7 Tech Support
1-888-872-7313
Financial Services/Payment Arrangements
1-885-646-0004
Visit us online
www.centurylink.com �
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Previous Balance Payments&Adjs Balance Forward Current Charges Amount Due Date Que
45.95 I 45.95 CR ( 0.00 I 44.58 I 44.58 I Jul. 26,2013
The Due Date On This Bill Applies to Current Charges Only � 6
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���,� CenturyLinkT
P.O. Box 1319
Charlotte, NC 28201-1319
Account Name: GEORGE H DITZEL Page: 2 of 5
Account Number: 313648437 Bill Date: Jul. 01,2013
• • • • • •
Ailocation of charges:
Service Categories Past Due Current Month Total Due
Basic Services o.o0 29.11 2s.i�
Other Services o.00 �s.a� 15.47
All Services o.oo aa.sa 44.58
Failure to pay Basic charges may result in the disconnection of those Services.Basic Service consists o#local phone -
service, interstate access charge,telecommunications relay surcharge, emergency 911 surcharge,installation and
otherfees.
Please contact CenturyLink regarding any questions or problems with your bill before the due date. A rate schedule,
an explanation of how to verify the accuracy of your bill and an explanation of specific charges can be obtained free
of charge by calling the customer service number listed on the first page.
Effective July 15,2013, CenturyLink will begin assessing a convenience fee of$4.00 for one-time payments
using a debit card, a credit card or an electronic funds transfer through a customer representative. You
can avoid this charge by paying your bill online at www.centurylink.com,through our automated phone system
or by mailing a check in advance of the due date. If you have any questions, please contact a CenturyLink
account representative at the number printed on your bill.Thank you for choosing CenturyLink for your
communication needs--we value you as a customer.
. CenturyLink works every day to bring you solutions that best meet your total communications needs. Stop in
and learn more about our value pricing that will help you reduce your household expenses when you bundle all
of your services with CenturyLink. You can also pay your bill and check out our newest products and services
at your local CenturyLink Customer Experience Center. Visit www.centurylink.com/stores to find the location
nearest you.
LATE FEE REMINDER: Late fees may be charged each month for any eligible unpaid balances
not paid in full by the due date listed on your bill.The methods for calculating late fee amounts vary by
state and product. For more information you may access Terms and Conditions, and Tariff materials at
http://www.centurylink.com/PageslAboutUs/Legal/Tar'rffs/displayTariffLandingPage.html?rid=tariffs,or
call GenturyLink customer service at the phone number indicated on this bill.
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P.O.Box 1319
Charlotte, NC 28201-1 31 9
Account Name: GEORGE H DITZEL Page: 1 of 4
Account Number: 313648437 Bill Date: Aug.01,2013
Contact Numbers Current Charges Summar� Detail Page
Product,Services and Billing
1-800-201-4099 � CenturyLink Local Services 3 1 .14
Repair Service
1-800-788-3600 Q CenturyLink Long Distance Services 4 2.a�
Payment or Account Balance 24/7 Total Current Charges 3.55
1-800-201-4099
High Speed Internet Tech Support 24l7
1-800-758-3600 -
Dial-up Internet 24/7 Tech Support
1-888-872-7313
Financial Services/Payment Arrangements
1-888-646-0004
Visit us online
www.centurylink.com
Previous Balance Payments&Adjs Balance Forvvard Current Charges AmOUnt QUe DBte Due �
44,58 ( 44.58 CR I 0.00 I 3.55 I 3.�J I AUg.26,2013
The Due Date On This Bill Applies to Current Charges Only 6
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P.O. Box 1319
Charlotte, NC 28201-1 31 9
Account Name: GEORGE H DITZEL Page: 1 of 4
Account Number: 313648437 Bill Date: Aug.01,2013
Contact Numbers Current Charges Summarv Detaii Page
Product,Services and Billing
1-800-201-4099 Q CenturyLink Local Services 3 1 .14
Repair Service
1-800-788-3600 � CenturyLink Long Distance Services 4 2.41
Payment or Account Balance 24R Total Current Charges 3.55
1-800-201-4099
High Speed Internet Tech Support 24l7
1-800-788-3600
Dial-up Internet 24/7 Tech Support
1-888-872-7313
Financial ServiceslPayment Arrangements
1-888-646-0004
Visit us online
www.centurylink.com
Previous Balance Payments&Adjs Balance Forvvard Current Charges AmOUnt Due Date Due �
44.58 I 44.58 CR I 0.00 I 3.55 I $.rjrj ( AUg.26, 2013
The Due Date On This Bill Applies to Current Charges Only s
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Stanley Steemer i
1960 E.College Ave, ;
Bellefonte PA 16823 (800)q45-774
Truck:26 Service Date:9/18/13
Crew: Patricia McCullough,Jesse Stambaugh Inv#:225981 '
Arrival Time:8:41 AM
Order Type: REG '
Wendy Freyvogel Acct#: 723199
42 Garden Parkway (717)561-1108 I
Carlisle,PA 17013 i
--------------------- -- --- --_ _______ i
Qty tem/Products _ Service Price i
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1 4 Area Special Clean $169.00
2BR,LR,SH '
SubTotal; $169.00 ,
Tax(6°k): $10.14
Total; $179.14
PAYMENT(S): '
Check#8689 $179.14
Balance �� C��
$0,00
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WARNING: Customer acknowledges being informed and
understands that ca�j;��* ,5 d�mp during and after cleaning and that
care shuuld be taken in stepping onto non-carpeted surFaces to
avoid slipping and hereUy releases Stanley Steemer from any and all
liability for injuries which might be sustained as a result thereof.
Customer-Not Available or Not Required To Siyn
Carpets loose at seams or along walls or concrete floois,or that have been '
incorrecdy or defec6vely instal►ed,are cleaned at cusGomei's risk.Carpets that have
been exposed to pets rriay sometimes not be able to deodorize effectively.Any
ques6ons regarding our workmanship must be reported within 10 days after
completio�of work or will Ue subject to a service charye at our option.
�
�USToM€R Ir1sTAUCTIOt�s
Leave protective coasteis and blocks in place for 3 days,
I I1AVE AUTHORIZED THE SERVICES OUTLINED ABOVE AND I
� UNDERSTAND THE CHARGES THEREFOR ARE DUE UPON THE
COMPLETION OF WORK
Customer Not Available or Not Required To Sign ',
Free carpet care Gps,order products�services online at
www.StanleySteemer.com
Wednesday,September 18,2013 8:42 AM
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THE WORLD�S LARGEST JUNK REMOVAL SERVICE !::
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� Lancaster,PA 17604
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, Bill Type:V-Volume,B-Bedload,S-Surcharge,SP-Standard Item Price Oth e r
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HOW DID YOU LEARN ABOUT US? Tax � '
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Job Sign ❑Yes ❑No
� ❑Cash ❑ Dis ❑CFieck# '` . ' ❑Voice Auth: ��
�� �M/C ❑VISA ❑�MEX Approval Code: �
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Date: E �
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j TERM5:All accouhtS are" e upon receipt u,_ s credit has been establiSh�.Overdu sounts are subject to interest not higlier than the i
j maximum allowable interest rate as determined by law.As owner,agent,or tenant of the above location,I herehy agree the work has heen �
Isatisfactorily completed and understand that I no longer own the items that have been removed.If a check is returned for any reason,I agree to i
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pay a$35 returned check fee.